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Background The purpose of this study was to describe the health status and work limitations in injured workers with musculoskeletal disorders at 1 month post-injury, stratified by return-to-work status, and to document their return-towork trajectories 6 months post-injury. Methods A sample of 632 workers with a back or upper extremity musculoskeletal disorder, who filed a Workplace Safety and Insurance Board lost-time claim injury, participated in this prospective study. Participants were assessed at baseline (1 month post-injury) and at 6 months follow-up. Results One month post-injury, poor physical health, high levels of depressive symptoms and high work limitations are prevalent in workers, including in those with a sustained first return to work. Workers with a sustained first return to work report a better health status and fewer work limitations than those who experienced a recurrence of work absence or who never returned to work. Six months post-injury, the rate of recurrence of work absence in the trajectories of injured workers who have made at least one return to work attempt is high (38%), including the rate for workers with an initial sustained first return to work (27%). Conclusions There are return-to-work status specific health outcomes in injured workers. A sustained first return to work is not equivalent to a complete recovery from musculoskeletal disorders.

Analyses using administrative and self-reported indices of work absence generally converged. Work accommodation and targeted HCP communication with the workplace are critical for effective early RTW interventions.

The experience of injured workers is influenced by multiple systems-the workplace, the healthcare system, and the workers' compensation system. Little research has been conducted on the impact of the workers' compensation system on injured workers' personal experience and on the justice of the workers' compensation process. The purpose of this study was to develop and validate a measure of the justice of the compensation process. Injured workers (n=446) with musculoskeletal injuries, in Ontario, Canada, filing a lost-time claim, completed a telephone survey 6 months post-injury. Exploratory and confirmatory factor analyses were conducted with two separate samples, and concurrent validity was examined. The four hypothesized factors emerged: distributive justice, procedural justice, informational justice, and interpersonal justice factors accounted for 96.3% of the variance. Confirmatory factor analyses had satisfactory fit indices to confirm the initial model. Alpha coefficients ranged from 0.86 to 0.92. Concurrent validity of the scale was supported: relationships of distributive and procedural justice with claim status, claim processing delay, perception of going back to work too soon, duration of work accommodation, and satisfaction with work accommodation were in the expected direction. Workers' experience of the justice of the compensation process can now be measured with a psychometrically sound and theoretically based instrument. This instrument offers researchers the opportunity to focus on the justice of the compensation process of injured workers. It can increase the attention that policy-makers, compensation management, healthcare providers, and other return-to-work stakeholders give to the impact of the compensation system and provide a broadened view of workers' experience.

Depressive symptoms are pervasive in workers with musculoskeletal injuries, but transient for some, and seldom diagnosed as depression or treated.